LIVING WITH IBS

Changes in diet, prescribing fibre like isabgol, anti-spasmodic drugs, counselling, are the usual ways that gastroenterologists tackle the garden variety of IBS. But, with emerging biopyschosocial model of IBS, new methods of treatment are coming up.

The first step is to eliminate possibility of any other medical condition that could be triggering bowel disorders – say, allergies like celiac disease, lactose intolerance and so on. Then comes the task of counseling the patient that there is no physical or chemical cause behind the syndrome – a fairly Herculean task sometimes. "Most IBS sufferers refuse to accept that there is nothing physically wrong with them and keep thinking they are harbouring a form of cancer," says Dr Deepak Lahoti, consultant gastroenterologist Max Balaji. That worry, in turn, aggravates fresh bouts of bowel disorders.

"It's essentially an open management question," says Dr Vivek Raj of Max Healthcare. The treatment approach varies from case to case. And doctor to doctor.

Also, as Artemis Healthcare's consultant gastroenterologist Dr Paramvir Singh points out, you really have to get into the patient's diet, lifestyle and medical history. In some cases, there are certain trigger foods that set off IBS in a patient. So, consumption of artificial sweeteners, carbonated beverages could be causing the problem. In others, IBS could be psychosomatic – here supportive psychotherapy works as it trains the patient to alter their response to the symptoms.

Another critical factor for patients is to understand diets, avoid the trigger foods, and learning to differentiate between soluble and insoluble fibre. For IBS patients, soluble fibre is what works. As does frequent small meals. Prebiotics (soluble fibre – examples are oats, whole grain, etc.) and probiotics (good bacteria) are also emerging as supportive therapy in many cases.

Talking to doctors, what emerges is that IBS is eminently manageable if treatment is customised on a case by case basis – although it takes time, patience, faith and cooperation to overcome it and make peace with it.

Even as these developments are happening, Indian gastroenterologists are doing their own surveys to find out whether western definitions of IBS fit the bill for India or we need one of our own. Three years ago a task force headed by Lucknow-based senior gastroenterologist, Uday Ghoshal set out to research the Indian gut with the purpose of developing an epidemiological and clinical profile of IBS sufferers in the country.

It was a massive inquiry involving close to 3,000 IBS patients and 4,500 community subjects from the length and breadth of India. The report of the task force was published earlier this year in the Indian Journal of Gastroenterology and, as Dr Gopalan points out, it is pretty significant because it shows that the Rome criteria – a set of guidelines used to diagnose IBS– cannot be applied wholesale in India.

To start with unlike the West, where most IBS sufferers are women, this survey turned up more men and that too predominantly middle-aged men. Parallel studies from Singapore and China also suggest that in the East, the syndrome afflicts more men than women.

Then again, more than half the patients in the Indian study complained of upper abdominal pain, whereas in the West, only a quarter report pain. Bowel disturbances in Indian patients were not as marked as those seen in the West. There were plenty of other technical details showing differences in the Indian situation – for instance, Dr Gopalan points out that in the western criteria IBS among children is accompanied by normal weight gain. But in Indian patients, coming from all strata of society, there were chronically malnourished cases too.

Revieiwing the findings of the study, Kok Gwan Gee, Consultant Gastroenterologist, Gleneagles Hospital, Singapore puts the whole significance of the study in perspective, when he points out, "Much of what we read about IBS is based on Western profiles. The Rome criteria focus on the relation to stool frequency and consistency, but ignore the relation to meals." As he says, what the task force has done is to strike out a brave new world for IBS in India. By challenging some of the assumptions of the Rome criteria, it opens new doors to understanding the syndrome in India and hopefully, pointing the way ahead

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